Document Type


Date of Award


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Michael A. Little

Second Advisor

Gary D. James


Problems endemic to Martha’s Vineyard’s health care system and community efforts to resolve them led to the this community study on Martha’s Vineyard, Massachusetts. Such problems included Martha’s Vineyard’s sole hospital and nursing home’s declarations of bankruptcy in 1996, the fluctuation of quality of Vineyard health care organization relations with the community overall, the rate of uninsured that was two times that of Massachusetts overall, the Island’s isolation from mainland medical services, and its health care service scarcities. This ethnography focuses on utilitarian values to explain difficulties that Vineyarders experienced during their efforts to obtain health care and to improve access to health care. Efforts to promote access included the development of health care policies and the formation of mainland and local organization business networks and of local community networks (Wellever 2004:228, 229-230).

Participant observation, structured interview (n=262) and archival data were used. Structured interviews were sought from Vineyarders who expressed an interest in health care. The Martha’s Vineyard Times Supplement (2006) list of property owners and their property values enabled interviews with Vineyarders of a wide range of property assessment values. Still others who had been employed by or had volunteered for a health care organization were found though recommendation, Vineyard media, and chance encounters.

This dissertation uses content analysis of actions performed by individuals, organizations, and communities. Utilitarian values were used to explain such actions. The types of utilitarian values could be thought of as “existing” along a continuum of egoistic (individualistic) utilitarian values and collectivistic utilitarian values or along the further extremes of exploitive egoistic and altruistic collectivistic values. Though Martha’s Vineyard’s communities were diverse, Vineyarders tended to be united by their sense of community. They made efforts to protect their communities from those they believed held opposing definitions that could threaten their communities. Such threats led Vineyarders to strengthen their community ties and to form new communities. Arguably, the malleable, versatile and imprecise (Cohen 1985:18, 21) symbol, “community,” promoted Vineyarders’ social solidarity. Their belief in “community” promoted harmonious social relations because it enabled individuals to reach surface agreements (Cohen 1985:18, 109).

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